12th Mycological Forum Registation

Registration Form – 12th Mycological Forum

Personal Information

First Name*

Last Name*

Postal Address*

Email*

Phone*

ID*

Institution / Workplace

Profession / Occupation

Will you submit an abstract to the Forum?*
YesNo

Registration Options

Type of Registration	Includes	AEM Members	Non-members
On-site Registration	Coffee breaks and lunch	60 €	85 €
Online Registration	–	45 €	60 €
On-site Registration + Closing Dinner (Friday, December 12)	Coffee breaks, lunch, and dinner	105 €	130 €

Total: ____________________________

Attendance is limited to 70 in-person participants
(online participation available with simultaneous translation into English).
Membership registration is available at:

https://aemicol.com/rules-of-registration/inscripcion/

Payment Information

Payment method: Bank transfer

Please transfer the total amount to the following account:

Banco Mediolanum — IBAN: ES73 0186 6001 87 0502589547

(You must attach proof of payment.)

Please attach a copy of the bank transfer.

Amount transferred (€)*

Transfer date*

Proof of payment (PDF/JPG/PNG, max 5 MB)*

Invoice Request (if needed)

Do you need an invoice?
Yes, I need an invoice

[conditional need-invoice]

Name or Institution

Tax/VAT Number (NIF/CIF)

Address

Postal Code

City

Province/State

Country

Phone

Billing Email

[/conditional]

Additional notes

I confirm that the information provided is correct and I accept the privacy policy.